<form method="post" action="{{$action}}" name="regform" ENCTYPE="multipart/form-data" onSubmit="return chkform(this)">
<input type="hidden" name="user_id" value="{{$currentUser}}"/>
<blockquote>
    <h3>{{$title}}</h3>
    <TABLE cellSpacing=0  width=600 cellpadding="0">
    <TBODY>
    <TR>
            <TD>
                    {{$LDInterconsultado}}
            </TD>
            <TD>
                    {{$sInterconsultadoInput}}
            </TD>
    </TR>
    <TR>
        <TD>
                {{$LDRespuesta}}
        </TD>
        <TD>
                {{$sRespuestaText}}
        </TD>
    </TR>
    <TR>
        <TD>
                {{$LDDiagnostico}}
        </TD>
        <TD>
                {{$sDiagnosticoText}}
        </TD>
    </TR>
    <TR>
        <TD>
                {{$LDTratamiento}}
        </TD>
        <TD>
                {{$sTratamientoText}}
        </TD>
    </TR>
    <TR>
        <TD>
                {{$LDObservaciones}}
        </TD>
        <TD>
                {{$sObservacionesText}}
        </TD>
    </TR>
    </TBODY>
    </TABLE>
    </blockquote>

    <p>
    {{$pbSubmit}}
    {{$pbReset}}
    <p>